If you wish to make a complaint about the service you have received from Amber Valley Borough Council please submit the form below, or alternatively please download the attached Complaint Form and send this to:

About You Section

Amber Valley Borough Council is committed to ensuring our services are accessible and designed to meet the diverse needs of Amber Valley communities. By completing this section you are helping us make sure we are meeting this commitment. You do not have to give this information if you do not wish to.

However we do request that you supply us with your full name at the beginning of the form. These fields are marked as mandatory and as a result will not let you submit the form without these fields completed. Thank You.

Customer Complaints Form

If you are complaining about a problem in your area (i.e. dog fouling, food complaint), as opposed to the service you have received from us, another online form may be more suitable. Take a look at our online reporting section to find the right form for you.

Complaint Details

1. Title

First Name(s)

Surname

Address

If the property is in the Amber Valley area please enter the postcode or the first few letters of the street. Otherwise enter the full address in the box below.

Contact Number

Email Address

2. Would you like feedback on your complaint?

How do you prefer to be contacted?

TelephoneEmailLetter

3. What is your complaint?

4. Do you consider your complaint to be related to any of the following?

16 to 17 Years18 to 24 Years25 to 34 Years35 to 44 Years45 to 54 Years55 to 59 Years60 to 64 Years65 to 74 Years75 Years and Over

Sexual orientation:

HeterosexualGayLesbianBisexualOther

If other, please specify your sexual orientation

Religion/belief:

BuddhistChristianHinduJewishMuslimSikhNo religionOther

If other, please specify your religion/belief

Disability

Under the Disability Discrimination Act a disabled person is someone who has a physical or mental impairment which has a substantial and long term adverse effect on their ability to carry out normal day to day activities.

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